The client is a 32-year-old multigravida at 28 weeks' gestation, who presents to the obstetrician's office for a routine has given burn three times; once at 35 weeks (twins), once at 38 weeks (singleton) and once at 41 weeks (singleton). All of these children are alive and well. She had one spontaneous abortion at 10 weeks' gestation. Her fourth child weighed 9 pounds (4.08 kg) at 41 weeks gestation.

The client is at 28 weeks. She has been receiving prenatal care since 8 weeks gestation. Her fasting 1-hour glucose screening level, which was done 1 week prior, is 164 mg/dL (9.1 mmol/L). Her 3-hour oral glucose tolerance test results reveal a fasting blood sugar of 168 mg/dL (9.3 mmol and a two-hour postprandial of 220 mg/dL (12...mol/L).

Scheduled the client to meet with the obstetrician, Diabetic Nurse Educator, and a Registered Dietician for the next day. After a discussion about gestational diabetes and seeking the client's input, a suggested plan of care is outlined, which includes dietary control and glucose self-monitoring.

The registered dietician (RD) discusses the need to

Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided.

The diabetic nurse educator instructs the client to perform fingerstick blood glucose (FSBG) monitoring Select Response

of the night at bedtime and in the middle

prior to each meal

every two hours throughout the day

during the middle of the night

Answer and Explanation

The Correct Answer is B

A)   Incorrect- While bedtime monitoring is important, the frequency described in this choice is not consistent with FSBG monitoring before meals.
B)   Correct- Performing FSBG monitoring before each meal helps the client track her blood glucose levels before consuming food, allowing her to adjust her diet or insulin regimen if necessary.
C)   Incorrect- Monitoring every two hours may be excessive and not necessary for managing gestational diabetes.
D)   Incorrect- Monitoring during the night is important for glycemic control, but it doesn't specifically address the need to monitor before meals.

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Correct Answer is C

Explanation

A) Incorrect- an audible voice when client is trying to communicate, indicates that the client has some air passing through the vocal cords, which may be due to a partially deflated cuff or a speaking valve. This is not a life-threatening situation, but the nurse should ensure that the cuff pressure is adequate and that the client is not experiencing any discomfort or aspiration risk.
B) Incorrect- This may indicate atelectasis, pneumonia, or pleural effusion in that lung area. The nurse should auscultate the client's lungs more thoroughly, monitor the client's oxygenation and ventilation parameters, and report the findings to the provider.
C) Correct- This finding suggests that the client may have a ventilator disconnect, a leak in the circuit, or a cuff leak, which can compromise the client's oxygenation and ventilation. The nurse should immediately check the ventilator connections and tubing, and assess the client's vital signs and oxygen saturation.
D) Incorrect- high-pressure alarm sounds when the client is coughing, which is a common occurrence in mechanically ventilated clients who have increased airway resistance due to secretions, bronchospasm, or coughing. The nurse should suction the client as needed, administer bronchodilators if prescribed, and ensure that the ventilator settings are appropriate for the client's condition.

A. Absence of coarse crackles. B. Increase in respiratory rate. C. Increase in breath sounds. D. Absence of fine crackles.

Correct Answer is A

Explanation

A) Correct - The absence of coarse crackles indicates that the airway has been cleared of secretions effectively, and the lung sounds are clearer.
B) Incorrect - An increase in respiratory rate could indicate distress rather than the effectiveness of the intervention.
C) Incorrect - An increase in breath sounds may not necessarily indicate the effectiveness of the intervention, as the quality of breath sounds matters more than the increase.
D) Incorrect - The absence of fine crackles might not directly indicate the effectiveness of the intervention, as other factors can influence lung sounds.

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Naxlex Comprehensive Predictor Exams

The nurse is managing 4 clients in the intensive care unit who are mechanically ventilated. After performing a quick visual assessment, the nurse should prioritize care for the client who is exhibiting which finding.

Correct Answer is C

Explanation

The nurse is performing tracheostomy care for a client who underwent a laryngectomy for laryngeal cancer. During the procedure, the client begins to cough and is unable to clear the secretions. After the nurse suctions the airway, which finding indicates the intervention was effective?

Correct Answer is A

Explanation

Before leaving the room of a confused client, the nurse notes that a half-bow knot was used to attach the client's wrist restraints to the movable portion of the client's bed frame. What action should the nurse take before leaving the room?

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The practical nurse (PN) is observing a newly hired PN who is preparing to administer a liquid medication via a client's feeding tube system as seen in the picture. What action should the PN take?

The nurse is performing a functional assessment on an older client who lost five pounds (2.27 Kg) of weight since the last visit 12 weeks ago, and who reports a decrease in energy and appetite. Which action should the nurse include during the assessment?

Find patient data about a client below. After the nurse assesses the client, the physician writes orders. The nurse reviews the orders. Which 2 orders should the nurse complete first?

When conducting diet teaching for a client who is on a postoperative full-liquid diet, which food(s) should the nurse encourage the client to eat? (Select all that apply.)